[1]王圣楠,卜荣生,杜静茹,等.CT-FFR参数联合斑块定量技术在心肌缺血再灌注损伤预测中的应用[J].中国医学物理学杂志,2023,40(1):66-70.[doi:DOI:10.3969/j.issn.1005-202X.2023.01.011]
　WANG Shengnan,BU Rongsheng,DU Jingru,et al.Predictive value of CT-FFR combined with plaque quantification for reperfusion injury in patients with myocardial ischemia[J].Chinese Journal of Medical Physics,2023,40(1):66-70.[doi:DOI:10.3969/j.issn.1005-202X.2023.01.011]
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CT-FFR参数联合斑块定量技术在心肌缺血再灌注损伤预测中的应用()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
40卷
期数:
2023年第1期
页码:
66-70
栏目:
医学影像物理
出版日期:
2023-01-07

文章信息/Info

Title:
Predictive value of CT-FFR combined with plaque quantification for reperfusion injury in patients with myocardial ischemia
文章编号:
1005-202X（2023）01-0066-05
作者:
王圣楠; 卜荣生; 杜静茹; 王耀国; 吴淳淳
福建医科大学附属第二医院心血管内科， 福建 泉州 362000
Author(s):
WANG Shengnan;  BU Rongsheng;  DU Jingru;  WANG Yaoguo;  WU Chunchun
Department of Cardiology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China
关键词:
冠状动脉; 心肌缺血; 再灌注损伤; 血流储备分数; 斑块定量技术; CT血管成像
Keywords:
Keywords: coronary artery myocardial ischemia reperfusion injury fractional flow reserve plaque quantification CT angiography
分类号:
R541；R814.42
DOI:
DOI:10.3969/j.issn.1005-202X.2023.01.011
文献标志码:
A
摘要:
目的：分析基于CT的血流储备分数（CT-FFR）联合斑块定量技术在心肌缺血患者再灌注损伤预测中的应用。方法：回顾性分析126例行择期经皮冠状动脉介入（PCI）治疗的冠心病（CHD）患者的临床资料，所有患者在PCI术前行冠状动脉CT血管成像检查，在PCI术后8 d内行心脏磁共振或光学相干断层成像判断再灌注损伤情况，将出现心肌微循环障碍（MVO）及（或）心肌内出血（IMH）者纳入再灌注损伤组，未出现MVO及IMH者纳入非再灌注损伤组。比较两组患者性别、年龄等基线资料及PCI术前CT-FFR值及斑块定量参数差异，利用受试者工作特征（ROC）曲线分析CT-FFR值及斑块定量参数对CHD患者再灌注损伤的预测价值。结果：再灌注损伤组多支血管病变率显著高于非再灌注损伤组（P<0.05），PCI后TIMI 3级率低于非再灌注损伤组（P<0.05）。两组最小管腔面积、钙化斑块体积、重构指数、偏心指数比较，差异无统计学意义（P>0.05）；再灌注损伤组CT-FFR值低于非再灌注损伤组（P<0.05），狭窄程度、斑块长度、非钙化斑块体积及斑块总体积均高于非再灌注损伤组（P<0.05）。ROC曲线分析显示，CT-FFR值、狭窄程度、斑块长度、非钙化斑块体积、斑块总体积均对CHD患者再灌注损伤具有较高预测价值（AUC=0.758、0.943、0.865、0.928、0.891, P<0.05），其Cut-off值分别为0.671、75.44%、38.61 mm、186.08 mm3、305.04 mm3，且5项联合预测价值最高（AUC=0.999, P<0.05）。结论：CT-FFR及斑块定量参数对预测CHD患者再灌注损伤有积极作用，可为CHD临床诊疗提供参考。
Abstract:
Abstract: Objective To analyze the value of CT-based fractional flow reserve (CT-FFR) combined with plaque quantification for predicting the reperfusion injury in patients with myocardial ischemia. Methods The clinical data of 126 patients with coronary heart disease (CHD) who were scheduled for percutaneous coronary intervention (PCI) were retrospectively analyzed. All patients underwent coronary CT angiography before PCI, and received cardiac magnetic resonance or optical coherence tomography within 8 d after PCI to assess the reperfusion injury. Those with myocardial microvascular obstruction (MVO) and/or intramyocardial hemorrhage (IMH) were included in reperfusion injury group, and those without MVO and IMH were enrolled as non-reperfusion injury group. The baseline data, such as gender, age, etc, and differences in CT-FFR and plaque quantitative parameters before PCI were compared between two groups. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of CT-FFR and plaque quantitative parameters for reperfusion injury in CHD patients. Results The multivessel lesion rate in reperfusion injury group were significantly higher than that in non-reperfusion injury group (P<0.05), while the rate of TIMI grade 3 flow after PCI was lower than that in non-reperfusion injury group (P<0.05). The differences between two groups in the minimum lumen area, calcified plaque volume, remodeling index and eccentricity index were trivial (P>0.05). Compared with non-reperfusion injury group, reperfusion injury group had lower CT-FFR, but higher degree of stenosis, longer plaque length, larger non-calcified plaque volume and total plaque volume (P<0.05). ROC curve analysis showed that CT-FFR, stenosis degree, plaque length, non-calcified plaque volume and total plaque volume had high predictive value for reperfusion injury in CHD patients (AUC=0.758, 0.943, 0.865, 0.928, 0.891 P<0.05), with the Cut-off values of 0.671, 75.44%, 38.61 mm, 186.08 mm3, and 305.04 mm3, respectively, and the predictive value of the combination of the 5 items was the highest (AUC=0.999, P<0.05). Conclusion CT-FFR and plaque quantitative parameters play a role in predicting reperfusion injury in CHD patients, and can provide a reference for the clinical diagnosis and treatment of CHD.

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备注/Memo

备注/Memo:
【收稿日期】2022-05-16 【基金项目】福建省中青年教师教育科研项目（JAT200110）；泉州市科技计划项目（2019N099S） 【作者简介】王圣楠，硕士，住院医师，研究方向：缺氧性心脏病机制，E-mail: Wsn199205393@163.com 【通信作者】吴淳淳，硕士，研究方向：宫内缺氧与子代心血管疾病相关机制，E-mail: Wcc77462397@163.com
更新日期/Last Update: 2023-01-07